The present study demonstrated that postconditioning may protect adult myocardium undergoing cold blood cardioplegic arrest. These data support the need for a further clinical trial of postconditioning in cardiac surgery.

Fontan procedure. Therefore, the sequence of events is consistent with the hypothesis that the increase in PA pressure may have been caused by obstructive tonsillar hypertrophy and was thereby reversed after tonsillectomy in this patient.Tonsillar hypertrophy is a common cause of OSA in children. Moderate-to-severe OSA is frequently associated with mild pulmonary hypertension, 3 which is characterized by mild pulmonary vascular remodeling and endothelial dysfunction, as shown in human and animal studies. 4,5 Therefore, it is possible that the magnitude of structural and functional alterations in pulmonary vasculature induced by nocturnal desaturation had significant impacts on the Glenn circulation, and that these changes were reversed after tonsillectomy in this case. Furthermore, it is interesting to speculate that such derangement in pulmonary circulation caused by OSA might have similar effects on hemodynamics in patients even after the Fontan procedure. This unique case implies that alleviation of OSA (ie, tonsillectomy) may be an efficacious treatment option for high-risk candidates for the Fontan procedure with high PA pressure after the Glenn procedure.

No abstract

Our study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

The postoperative course of cyanotic patients is generally more complicated than in acyanotic patients. The ischemic postconditioning provides protection from myocardial injury. We conducted a randomized trial to evaluate the clinical benefits of postconditioning in patients undergoing repair of tetralogy of Fallot. Ninety-nine patients with tetralogy of Fallot were randomly assigned to ischemic postconditioning group (n=48) or control group (n=51). The postconditioning was performed by intermittent aortic clamping after reperfusion. The morbidity, mortality, ventilation time, length of ICU stay, inotropic score, release of troponin I and lactate were assayed. There was one death in postconditioned group and two in control. Major non-fatal morbidity was reduced in postconditioned patients (12.5%, 6/48) compared with control (33.3%, 17/51, P=0.016). The troponin I was significantly lower (P=0.026) with reduced inotrope score (P=0.001) and lactate release (P=0.019) in postconditioned patients. The ventilation time was significantly reduced in postconditioned patients compared with control (14+/-15 h vs. 25+/-28 h, P=0.024). There was a significant decrease in the ICU stay in the postconditioned patients (P=0.048). The study suggests that ischemic postconditioning may provide clinical benefits with respect to the morbidity, ventilation time, ICU stay, requirement of inotrope in patients undergoing repair for tetralogy of Fallot.